Physical activity, exercise, and sports influence behaviors, thoughts, and emotions. Similarly, what people do, how they think, and emotional responses influence the participation and performance of individuals in physical activity, exercise, and sports. Promoting participation in physical activity and enhancing performance in exercise and sports requires an understanding of the increasing evidence base connecting psychology with exercise and sport.
Only 50% of U.S. adults engage in recommended physical activity levels. Healthy adults between 18 and 65 years old should engage in moderate-intensity aerobic physical activity (e.g., brisk walking) for at least 30 minutes 5 days a week or vigorous-intensity aerobic physical activity (e.g., jogging) for at least 20 minutes 3 days each week. Additionally, these adults should engage in physical activity that maintains or increases muscle strength and endurance at least 2 days a week (18).
There is increasing evidence that physical activity and exercise are effective interventions for ameliorating depressive symptoms (26). For example, when those diagnosed with a major depressive disorder exercised at levels consistent with public health recommendations, their depressive symptoms decreased more than those who exercised less (11). Exercise was shown to decrease depressive symptoms as much as antidepressant medications (4). A systematic review also found at least a small positive effect for exercise-reducing depression and anxiety symptoms among children and adolescents (24).
It is important to target physical activity early in life. Adolescents who have a more positive view of physical activity and sport engage in more physical activity 5 and 10 years later (16). Among adolescents and children, educationonly interventions to increase activity are not effective (47). However, for adolescents, school-based multicomponent interventions (i.e., education combined with environmental or policy changes) and interventions that include school and family or community involvement are associated with increased activity (47).
Simple interventions can increase physical activity. For example, wearing pedometers, along with having a step goal (e.g., 10,000 steps per day), is associated with significant increases in daily physical activity (6). Also, using point-of-decision prompts, such as signs placed near escalators and elevators encouraging the use of stairs, significantly increases the likelihood of stair use (42).
In 2002, the U.S. Preventive Services Task Force concluded that there was insufficient evidence that counseling adults to increase physical activity in primary care settings results in sustained changes in physical activity (12). However, England’s Public Health Interventions Advisory Committee determined in 2006 that there was sufficient evidence supporting brief counseling interventions for increasing physical activity in primary care settings (15).
According to the National Institute for Health and Clinical Excellence (NICE), inactive individuals should be identified in primary care settings, and the patients’ specific needs, preferences, and circumstances should be considered when setting goals with them. Patients should be followed over a 3- to 6-month period to sustain physical activity increases (15).
Although disordered eating behaviors and substance use have been studied among athletes, very little is known about other psychological concerns and disorders, including anxiety disorders, attention-deficit hyperactivity disorder (ADHD), bipolar disorder, depression, overtraining syndrome, psychosis, and suicidality (39).
Disordered eating behavior can range from that which meets clinical diagnostic criteria for anorexia nervosa (Table 79.1) or bulimia nervosa (Table 79.2), as established in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision (DSM-IV-TR), to subclinical levels of disordered eating behavior, which might include occasional purging and/or laxative use or diet pill use, referred to as “eating disorder not otherwise specified” in the DSM-IV-TR.
It is important to recognize that bingeing and compensatory purging may be a feature of anorexia nervosa or bulimia nervosa.
Targeted programs may help reduce the risk of disordered eating behavior among adolescent athletes (14).
Table 79.1 DSM-IV-TR Criteria for Anorexia Nervosa
A.
Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).
B.
Intense fear of gaining weight or becoming fat, even though underweight.
C.
Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
D.
In postmenarchal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen, administration.)
Specify type:
Restricting Type: during the current episode of anorexia nervosa, the person has not regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).
Binge Eating/Purging Type: during the current episode of anorexia nervosa, the person has regularly engaged in binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).
SOURCE: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., text revision. Washington (DC): American Psychiatric Association; 2000.
Table 79.2 DSM-IV-TR Criteria for Bulimia Nervosa
A.
Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
1)
Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
2)
A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
B.
Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise.
C.
The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.
D.
Self-evaluation is unduly influenced by body shape and weight.
E.
The disturbance does not occur exclusively during episodes of anorexia nervosa.
Specify type:
Purging Type: during the current episode of bulimia nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas.
Nonpurging Type: during the current episode of bulimia nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas.
SOURCE: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., text revision. Washington (DC): American Psychiatric Association; 2000.
Disordered eating behaviors may be more common among athletes than in the general population. Although there has been variability in prevalence rates of eating disorders in athletes, researchers demonstrated that in a sample of elite athletes, the overall prevalence of eating disorders was 13.5% compared to 4.6% in controls. For elite athletes meeting criteria for an eating disorder, 32.4% were men (44). Disordered eating is not confined to female athletes, and assessment of eating behavior in both females and males is important.
Anorexia nervosa signs and symptoms include increasing restrictions in food consumption, social avoidance, “excessive” physical activity, which may include maintaining a rigid posture or excessive standing, being hungry less often and being full sooner, and beliefs of being too heavy despite being thin or underweight. Emotionally, individuals may demonstrate depressive symptoms, irritability, and obsessional thoughts (23). Physically, in addition to amenorrhea in women, individuals may demonstrate constipation, headaches, fainting, dizziness, fatigue and cold intolerance, dry skin, hair loss, bradycardia, orthostatic hypotension, hypoglycemia, hypothermia, and leukopenia (38).
Signs and symptoms of bulimia nervosa include some methods of getting rid of calories and diminished perceived control over eating (23). Binge eating usually occurs very rapidly,
often with self-determined “forbidden foods” and while the individual is alone. The binge may involve a total calorie count from several hundred calories to more than 10,000 calories (23). Individuals may demonstrate overly restrained eating outside of binge eating episodes (23). Physical signs and symptoms may include bloating; fullness; lethargy; gastroesophageal reflux disease; abdominal pain; knuckle calluses; dental enamel erosion; hypochloremic, hypokalemic, or metabolic alkalosis; hypokalemia; and elevated salivary amylase (38). However, none of these physical signs and symptoms may be present, and the individual may still be engaging in regular binging and compensatory behaviors.
Risk factors for developing disordered eating include:
Psychological factors such as body dissatisfaction, negative affect, low self-esteem, and perfectionism; sociocultural factors promoting unrealistic thinness standards; and participation in a variety of sports, not only sports promoting lean builds (e.g., gymnastics, figure skating) (21). For men, distance running, wrestling, body building, lightweight football, horseracing, rowing, and ski jumping have been associated with disordered eating.
The National Athletic Trainers Association presented recommendations for preventing, detecting, and managing disordered eating in athletes (5). Key recommendations include the following:
Develop policies and plans for detecting and managing disordered eating and establish screening methods to identify disordered eating as soon as possible. It is unlikely that athletes will self-identify eating problems.
Screening should include measures designed specifically for athletes, interviews, observations of behavior, and monitoring of body composition. Standard eating disorder screening measures may not have been validated with athletes. The ATHLETE Questionnaire has been shown to be a valid and reliable measure of psychological predictors of disordered eating among athletes (20).
When disordered eating is suspected, health care providers should conduct a thorough evaluation. If treatment is indicated, medical, dietary, behavioral, and cognitive interventions are necessary for effective treatment.
The “female athlete triad” was coined by the American College of Sports Medicine® (ACSM) in 1992 to describe three interrelated conditions of functional hypothalamic amenorrhea, premenopausal osteoporosis, and disordered eating that often occur together in female athletes (31).
In the most recent ACSM position stand on the female athlete triad (32), it is recommended that females are screened for symptoms at preparticipation or annual health screening exams. Athletes who demonstrate one of the triad components should be screened for the other components.
According to the ACSM (32), treatment for those demonstrating the female athlete triad should focus on increasing energy availability (i.e., increasing energy intake and/or reducing energy expenditure) through nutritional counseling. Those who are demonstrating disordered eating and eating disorders should receive nutritional counseling and individual psychotherapy. It may be necessary to restrict athletes not adhering to treatment recommendations from training and competition.
Table 79.3 DSM-IV-TR Criteria for Substance Abuse | |||||||||||||||||||||
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In a survey of 19,676 college student athletes by the National Collegiate Athletic Association (NCAA) regarding substance use habits, 76.9% reported using alcohol in the preceding 12 months, making it the most commonly abused substance by athletes (45).Related posts:
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